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目的确定扩散加权MR成像对预测原发性头颈部鳞状细胞癌(HNSCC)治疗失败的诊断性能。材料与方法本研究获得机构伦理委员会批准,所有参与本研究患有原发HNSCC接受放射治疗和化学治疗的病人均签订知情同意书。有37例病人在治疗前进行了原发肿瘤的扩散加权MR成像,30例病人在治疗后2周内再次接受了扩散加权成像检查。对表观扩散系数(ADC)直方图进行分析,使用Studentt检验对在2年内局部破坏和局部控制区域的平均ADC值、峰态、偏度、各自的百分比变动进行了相关分析。通过使用逻辑回归方法对ADC参数、T阶段、肿瘤体积等参数的单变量或多变量分析来预测破坏区域。结果 37例病人中有16例(43%)病人出现破坏区域,有21例(57%)病人出现局部控制区域。治疗前ADC参数表明与破坏区域没有相关性。病人组全部病人在治疗过程中平均ADC值显著升高,峰态、偏度与治疗前比较显著下降(分别为P<0.001,P<0.001,P=0.024)。在治疗过程中,原发肿瘤的平均ADC值百分比升高不显著,破坏区域与局部控制区域比较具有更高的峰态和偏度(分别为P=0.016,0.015,0.040)。通过使用多变量和单变量分析发现ADC参数可以显著地预测局部破坏。结论早期治疗中DW成像可以潜在地预测HNSCC病人原发肿瘤部位对治疗的反应。
Objective To determine the diagnostic performance of diffusion-weighted MR imaging in predicting the failure of primary head and neck squamous cell carcinoma (HNSCC) treatment. Materials and Methods The study was approved by the Institutional Ethics Committee and all patients who participated in the study with primary HNSCC undergoing radiotherapy and chemotherapy were given informed consent. Thirty-seven patients underwent diffusion-weighted MR imaging of primary tumors prior to treatment and 30 patients underwent diffusion-weighted imaging within two weeks of treatment. Histograms of Apparent Diffusion Coefficients (ADCs) were analyzed and Studentt’s test was used to correlate mean ADC values, kurtosis, skewness, and their respective percentages of changes in local damage and locally controlled areas within 2 years. Predict the failure area using univariate or multivariate analysis of parameters such as ADC parameters, T-stage, tumor volume, etc., using a logistic regression method. RESULTS: Of the 37 patients, 16 (43%) developed disrupted areas and 21 (57%) developed locally controlled sites. ADC parameters before treatment showed no correlation with the damaged area. The average ADC value of all patients in the patient group was significantly increased during treatment, and the kurtosis and skewness were significantly decreased compared with those before treatment (P <0.001, P <0.001, P = 0.024, respectively). During the course of treatment, the average percentage of ADCs in the primary tumor did not increase significantly, and the damaged and the locally controlled regions had higher kurtosis and skewness (P = 0.016, 0.015 and 0.040, respectively). Using multivariate and univariate analysis, it was found that ADC parameters can significantly predict local damage. Conclusions DW imaging during early treatment can potentially predict the response of the primary tumor site to treatment in HNSCC patients.